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d y z <br /> Burnett County Office of Zoning Administrator kn <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT <br /> To the Zoning Administrator: The undersigned hereby makes application for <br /> a Permit for the work described and located as shown herein. The undersigned agrees that <br /> all work shall be done in accordance with the requirements of the County Zoning Ordinance, <br /> Sanitation Code, and with all other applicable County Ordinances and the ,laws and regu- <br /> lations of the State of isconsin-. i ` .fD, <br /> /e�_or Agent (please p/rint) Contractor or Surveyor ;'\ 1 <br /> Address Address \ " <br /> ......... . . .. .. ... . .. .. .. .... . . ... . . .. .. .. .... ...... .. ...... .. . . . . . . . . . <br /> PhonePhone \ :� <br /> . <br /> Plumber Well Driller <br /> 1.5. . . . . . . . . . . . . . . . ........... ........ . h <br /> Address Address <br /> ��X J .-.�1.3O.......... ........... . . . . . . . . . . . . . . . . . . . . . .. . . ... .. ......... <br /> Phone Phone o <br /> DESCRIPTION 4. Building Details 7. Sanitary Facilities <br /> 1. Work (check one) - Type, Construction No. Bathrooms .✓'r <br /> New Building / T ✓� {•....... .. Dishwasher <br /> r Garbage Grinder <br /> Addition : :•••�/ Size � ft. x �C!.ft. Autom. Laundry <br /> Sanitary !/ No. Bedrooms <br /> Alterations Height . . . . Stories . . .. <br /> Waste Disposal <br /> Moving AreaS stem <br /> Wrecking . ..... Septic )�TanSize <br /> Mobile Home . .. .. . 5. Permits Required �C �L' Gallons F <br /> Privy Subdivision Absorption Field Site a m <br /> Well L• : Sanitary v Soil Type S <br /> / <br /> Subdivision . . . . • Building �•�' Slope . . . . ........... . <br /> Well ✓ Pere. Rate d <br /> y) . . . . . . <br /> Other (Specify)2. Classification Dry Well . .... . <br /> Conditional . . . . . . <br /> Zoning Dist. . . . .. Seepage Trench ... . � : <br /> Land Privy / 3 `• : <br /> 1 <br /> 3. Lot Size 6. Use (describe exactly, �1• Seepage Bed c <br /> fam. ho�qe motel, etc.) FOR COMMERCIAL USE <br /> ft. x . . . . . . . ft. <br /> Plans Submitted . . . . <br /> sq. ft. Plans Approved . . . . . . : o <br /> NOTE: A preliminary site inspection must be made and site approval granted on all struc- <br /> tures involving sanitary facilities before construction can begin. In the case of sewerage dis- <br /> posal systems, a copy of the percolation test must be attached to this application before a <br /> permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any <br /> building until a permit has been issued. A permit may be revoked if misrepresentation of <br /> any of the information conveyed herewith is found to exist. Changes in plans or specifica- <br /> tions shall not be made without approval of the Zoning Administrator. SEWER SYSTEM <br /> SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />